A 72-Year-Old Woman With Hemorrhagic Bullae Over the Dorsal Hand: Answer

Nocardiosis ‘great imitator’: unusual disease with usual presentations at unusual site

“…In accordance with previous reports, our patient's infection involved the upper extremities, a less common occurrence. 2,3 Furthermore, the persistence and relapse of infection in the presence of diabetes might suggest a role of host factors influencing the disease's course, as observed in similar cases. 11,13 Microbiological identification of Nocardia farcinica from the culture-sensitivity report highlighted importance of antimicrobial susceptibility testing.…”

“…2,5 This case was clinically indistinguishable from other skin infections, resulting in delayed identification despite routine investigations. 2,10 Surgical intervention became necessary due to the persistence of symptoms despite conservative management. Careful dissection preserving the superficial branch of the radial nerve revealed a pus pocket during the procedure.…”

“…This delayed identification underscores the importance of considering Nocardia as a differential diagnosis in cases where clinical manifestations mimic those of other more commonly encountered bacterial or fungal skin infections. 2,10 Our case presentation, focusing on a 50-year-old female with type 2 diabetes presenting with cutaneous nodules, bullae formation, and serosanguinous discharge, highlights the complexities in diagnosing primary cutaneous nocardiosis. 2,5 This case was clinically indistinguishable from other skin infections, resulting in delayed identification despite routine investigations.…”

“…2,10 Our case presentation, focusing on a 50-year-old female with type 2 diabetes presenting with cutaneous nodules, bullae formation, and serosanguinous discharge, highlights the complexities in diagnosing primary cutaneous nocardiosis. 2,5 This case was clinically indistinguishable from other skin infections, resulting in delayed identification despite routine investigations. 2,10 Surgical intervention became necessary due to the persistence of symptoms despite conservative management.…”

“…Cutaneous infections (most commonly by N. pseudobrasiliensis) are usually seen on feet in immunocompetent hosts and are of three subtypes namely (1) lympho-cutaneous (clinically similar to sporotrichosis), (2) superficial, and (3) mycetoma (chronic infection with discharging sinuses). 2 CNS spread though less common can be fatal as seen with systemic involvement in immunocompromised patients. 3 Centres for disease control and prevention reckons around 500-1000 cases annually in US.…”